Traumatic Retrobulbar Hemorrhage

Orbital and ocular contusion can produce retrobulbar hemorrhage sufficient to damage the orbital vasculature and cause exophthalmos, iridocyclitis, and lagophthalmos. This occurs most often in dogs, horses, and cats. The exophthalmos and resultant lagophthalmos are associated with an impaired blink reflex and acute exposure ulcerative keratitis. Subconjunctival and intraocular hemorrhage may also be present, and the latter can prevent intraocular examination. Corneal and scleral lacerations should be excluded by ophthalmic examination, and B-scan ultrasonography to detect retinal detachment is recommended in eyes with intraocular hemorrhage.

Medical and surgical therapy consists of topical and systemic antibiotics and corticosteroids, mydriatics if pupillary dilation is necessary, and a complete temporary tarsorrhaphy to protect the cornea until a brisk blink reflex returns. Prognosis is guarded, because secondary glaucoma and phthisis bulbus are not infrequent. Intraocular hemorrhage is usually allowed to reabsorb.